For the Sexual Revolution we say – Thank you Antibiotics?

2013-02-10

Two years ago, we were out on a busy street when my darling son turned to me and asked loudly “Oh my god Mom! Are you sure you don’t have syphilis?!” I don’t, of course, but apparently after watching an episode of the medical TV series House he had decided that “Are you sure you don’t have syphilis?” was a perfectly good substitute for the expression “Are you crazy?” Needless to say, he has never said it again.

Despite relatively low levels of promiscuity in the past, syphilis used to be a common disease; in 1939 syphilis killed 20,000 people in the United States. Today, thanks to access to antibiotics, the prevalence has fallen to a nearly insignificant numbers, with only 27 deaths in the US due to syphilis in 2010.

New research by Andrew Francis (whose work has graced our pages at Dollars and Sex before) would argue that my statement above is not quite correct. It finds that syphilis wasn’t high in the past despite low levels of promiscuity, but rather promiscuity was low in the past because of the high rates of syphilis. In fact, it goes even farther – giving credit to antibiotics for the rising rates of pre-marital sexual activity over the 20th century.

This isn’t the first time we have heard a story that explains rising rates of promiscuity as a function of a medical advance. For years our general societal slutiness has been blamed on the introduction of oral contraceptives – better know as the “the pill”.

That story goes something like this: men and women avoided being promiscuous in the past because promiscuity put individuals at risk of paying the high cost of unplanned pregnancy. An unplanned pregnancy, until very recently, was not only a burden on resources, but imposed a burden in terms of social stigma as well. When the costs outweighed the benefits, which they frequently did, men and women postponed sex until they were married (or at least almost married).

With the introduction of oral contraceptives, the risk of unplanned pregnancy decreased and, over time, social norms evolved reducing the stigma associated with sex outside of marriage. The problem with this story has always been that over the whole period since the pill was introduced the rate of births outside of marriage have increased, not decreased, which is unexpected if you want to argue that sex outside of marriage is less costly today than it was in the past.

The antibiotic / syphilis story is nearly identical – the costs of promiscuity in terms of sexually transmitted infection has fallen dramatically with the introduction of a drug that can fight off this deadly infection with just one dose. And this story, is happily consistent with the evidence that births outside of marriage have been increasing since the treatment has become available.

So are we ready to throw out the whole birth control story and replace it with an antibiotic story? I think not quite yet.

The problem is that at the same time that antibiotics became available the latex condom was also making its way on to the market and, more importantly, was becoming less expensive and more reliable than previous methods of avoiding both disease and pregnancy.

During WWII the US military actively promoted condom use to soldiers for the prevention of sexually transmitted disease. That knowledge was likely to have spilled over into society at the same time antibiotics to treat those diseases became available. It is easy to argue that people were willing to risk becoming infected with a disease that could be treated, but it more convincing (especially in this prudish era) to argue that people were more willing to have sex when the disease could be avoided in the first place.

The bottom line is this. I think we can all agree that technological / medical changes over the twentieth contributed to a declining cost of promiscuous behavior and, as a result, an increase in that behavior and an evolution of social norms towards its acceptability. Antibiotics might be an important part of that story, but they are still only one part of a far more complex explanation that cannot ignore the role played by other technologies.

Big thank you to Neil McArthur, author of the fascinating blog Moral Lust, for sending this new research my way.

Comments

Is there any solid data on what rates of pre-marital sex were before the 20th century? It sometimes seems that a lot of the discussion about the rise of pre-marital sex post-WWII is more about it’s increasing visibility, but without knowing what the rates were before, how can one distinguish between a rise in the rate and a simply an increase in people’s acknowledging what had already been happening. Lacking any of that context, many of these “explanations” seem more like Just-So stories to me. Also, if we are just talking about a very narrow definition of sex (heterosexual vaginal intercourse), then perhaps there are some inferences about rates of pre-marital sex that can be made, but there are an awful lot of sexual activities that don’t lead to pregnancy, and I’m not egotistic enough to think that my generation invented them.